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A Weekly Health Policy Round Up From Health Affairs            

**November 24, 2019**

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FOLLOWING THE ACA

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Third Court Rules Against Provider Conscience Rule

By Katie Keith (11/20/19)

Yesterday, Judge William Alsup, a federal district court judge in the
Northern District of California, became the third judge to vacate a
provider conscience regulation in less than two weeks.Read More >>

CONSIDERING HEALTH SPENDING

MSSP Participation Following Recent Rule Changes: What Does It Tell Us?

By Michael E. Chernew, Andres de Loera-Brust, Vinay Rathi, and J.
Michael McWilliams  (11/22/19)

Recently released CMS data on MSSP participation in 2019 raise concerns
that the program has now become much less attractive to providers. Read
More >>

Untangling The Relationship between Social Service And Health Care
Spending And Health Outcomes

By Elizabeth H. Bradley and Amanda Brewster (11/18/19)

As policy makers, researchers, and practitioners, we would do well to
find the language to discuss health care and social services that does
not invoke a zero-sum game but rather considers carefully how to better
support upstream services while encouraging efficiency and value for
downstream services. Read More >>

AFFORDABLE CARE ACT

ACA Marketplace Plan Affordability Is Likely To Decrease For Subsidized
Enrollees In 2020

By David Anderson, Andrew Sprung, and Coleman Drake (11/22/19)

Policy actions that reduce premiums, such as the reinsurance programs
implemented or in progress in a growing number of states, stand to
increase out-of-pocket premiums for some enrollees and decrease them for
others. Read More >>

SUBSTANCE ABUSE

The Opioid Epidemic: A Needed Focus On Adolescents And Young Adults

By Julie Uchitel, Scott E. Hadland, Sudha R. Raman, Mark B. McClellan,
and Charlene A. Wong (11/21/19)

From new payment models to specific care delivery strategies, the
spectrum of reforms described here to reduce the harms from opioids to
Generation Z can support them in their adolescence and young adulthood,
with benefits to be realized over a lifetime. Read More >>

RURAL HEALTH CARE

Right-Sizing Evidence-Based Programs To Improve Rural Health Care

By Elizabeth Ruen (11/21/19)

Billings Clinic, an integrated health system in Montana, adapted the
Alameda Model of emergency psychiatric care for its use. The staff
believed that this evidence-based model from an urban area in California
could be "right-sized" to serve a smaller population in a rural and
frontier region. The author reports some promising early results at
Billings Clinic's psychiatric stabilization unit. The Leona M. and Harry
B. Helmsley Charitable Trust played an important role in those
successes.
Read More >>

LEGAL AND REGULATORY ISSUES

United States v. Gilead: Can a Lawsuit Yield Better Access To PrEP?

By Christopher J. Morten and Amy Kapczynski  (11/18/19)

This lawsuit comes after a wave of pressure, beginning in Spring 2019,
from a coalition of activists, HIV care providers, and civil society
groups organized by the PrEP4All Collaboration, urging HHS and its
constituent agency, the CDC, to assert government-owned "patents for
PrEP" against Gilead. Read More >>

HOSPITALS

A Look Inside The Hospital Transparency Final Rule

By Billy Wynne, Josh LaRosa, and Taylor Cowey (11/18/19)

CMS finalized a controversial set of requirements for the disclosure of
hospital pricing data to degrees heretofore not seen. While the original
proposal faced substantial backlash from stakeholders, CMS' final
decision is nearly identical to what the agency originally proposed.
Read More >>

PAYMENT

Private Equity And Powerful Physician Groups Raise Another Distraction

By Hunter Kellett, Alexandra Spratt, and Mark E. Miller (11/19/19)

Congress can help close a damaging loophole in the health care system by
bringing everyone to the negotiating table. Read More >>

PHARMACEUTICALS & MEDICAL TECHNOLOGY

Toward Continuous Evidence-Based Treatment For Opioid Use Disorder:
Lessons from North Carolina

By Aaron McKethan, Hilary Campbell, Andrew Olson, Susan Kansagra, Elyse
Powell, and Emma Sandoe (11/19/19)

We aim to draw attention, both within and beyond North Carolina, to
learning that can increase the rate at which people with OUD receive
appropriate, ongoing, evidence-based treatment. These findings are
relevant for North Carolina and, we believe, instructive for state and
federal policy making as we explore ways to make further progress
related to the opioid epidemic. Read More >>

COMMUNITY HEALTH

Lessons About Leading For Racial Equity From Seattle's Health Care For
The Homeless Network

By John Gilvar (11/20/19)

In the HCHN experience, normalizing discussions about race and racism
led to a much deeper appreciation of the barriers to trust and
accumulated experiences of aggression with which many people of color
must continually grapple. Read More >>

PALLIATIVE CARE

States Take Up Palliative Care: NASHP's Work With The John A. Hartford
Foundation

By Trish Riley and Kitty Purington (11/20/19)

States can play a critical role in educating the public and providers
about the value of palliative care services and their place in a
comprehensive system of care for people with serious illness and/or
chronic conditions. Following a recent National Academy for State Health
Policy meeting, the authors discuss ways to promote access to and
quality of palliative services and how to address common roadblocks to
implementing them in the states.
Read More >>

HEALTH AFFAIRS EVENTS-Rural Health

Wednesday, December 4, 9:00 am - 1:00 pm Eastern
National Press Club - 529 14th Street NW, Washington DC (Metro Center)
Registration Now Open

The December 2019 issue of Health Affairs explores various dimensions of
health and health care in rural America. Authors examine the health
needs of people living in rural areas, investigate inequities in the
availability, accessibility, and financing of care, and identify
policies, financing mechanisms, and practices that can improve the
health and well-being of rural Americans. Join us for a forum during
which authors will present their work and participate in a robust
discussion:

* David Anderson, Research Associate, Health Policy Evidence Hub,
Margolis Center for Health Policy, Duke University, on "Rural-Urban
Differences In Individual Market Health Plan Affordability After Subsidy
Payment Cuts"

* Abigail Barker, Research Assistant Professor, Washington University in
St. Louis, and Center for Rural Health Policy Analysis at the Rural
Policy Research Institute, University of Iowa, on "Effect Of
Population Size On Rural Health Insurance Premiums In The Federal
Employees Health Benefits Program"

* Michael Lawrence Barnett, Assistant Professor of Health Policy and
Management, Harvard T. H. Chan School of Public Health, on "Adoption
of Buprenorphine Waivers by Advanced Practice Providers Highest in Rural
Areas with Expanded Scope of Practice"

* Kevin Bennett, Associate Professor, Director of the Research Center
for Transforming Healthcare, and Director of the South Carolina Center
for Rural & Primary Healthcare, University of South Carolina School of
Medicine, on "What is Rural, Anyway?"

* Hayley Germack, Assistant Professor, Acute & Tertiary Care, University
of Pittsburgh School of Nursing, on "When Rural Hospitals Close, the
Physician Workforce Goes"

* Carrie Henning-Smith, Assistant Professor, Division of Health Policy
and Management, University of Minnesota School of Public Health, on
"Rural Counties With Majority Black Or Indigenous Populations Suffer
Highest Rates Of Premature Death"

* Kenton Johnston, Assistant Professor, Health Management and Policy,
College for Public Health and Social Justice, St. Louis University, on
"Why Do Rural Medicare Beneficiaries Have Higher Rates of Preventable
Hospitalization and Mortality?"

* James Kirby, Senior Researcher, Center for Financing, Access, and Cost
Trends, Agency for Healthcare Research and Quality, on "Rural
Residents With Mental Health Needs Have Fewer Care Visits Than Urban
Counterparts"

* Katy Backes Kozhimannil, Associate Professor, Division of Health
Policy and Management, University of Minnesota School of Public Health,
on "Rural-Urban Differences In Severe Maternal Morbidity And Mortality
In The US, 2007-15"

* Leighton Ku, Professor, Department of Health Policy and Management,
Milken Institute School of Public Health, George Washington University,
on "Enhancing Staffing In Rural Community Health Centers Can Help
Improve Behavioral Health Care"

* Claire O'Hanlon, Advanced Fellow in Health Services Research, Veterans
Affairs Center for the Study of Healthcare Innovation, Implementation &
Policy and Adjunct Policy Researcher, RAND Corporation, on "Access,
Quality, And Financial Performance Of Rural Hospitals Following Health
System Affiliation"

* Scott G. Phillips, Editor in Chief, Rural Health Quarterly, Texas Tech
University Health Sciences Center, on "Higher US Rural Mortality Rates
Linked To Socioeconomic Status, Physician Shortages, And Lack Of Health
Insurance"

* Janice Probst, Distinguished Professor Emerita, Rural and Minority
Health Research Center, Arnold School of Public Health, University of
South Carolina, on "Structural Urbanism Contributes To Poorer Health
Outcomes For Rural America" and "Declines In Pediatric Mortality
Fall Short For Rural Children"

* Scott Shipman, Director of Clinical Innovations; Director of Primary
Care Initiatives, Association of American Medical Colleges, on "The
Decline In Rural Medical Students: A Growing Gap In Geographic Diversity
Threatens The Rural Physician Workforce"

* Sirin Yaemsiri, Senior Statistician, U.S. Government Accountability
Office, on "Healthy People 2020: Rural Areas Lag In Achieving Targets
For Major Causes Of Death"

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IN THE JOURNAL

AHEAD OF PRINT

Declines In Pediatric Mortality Fall Short For Rural US Children

By Janice Probst, Whitney Zahnd, and Charity Breneman

While pediatric death rates have declined nationally, disparities remain
for some groups of children. Janice Probst and coauthors analyzed
mortality data from the Centers for Disease Control and Prevention,
finding that rural youth ages 0-19 were more likely than urban youth
to die during childhood throughout the period from 1999 through 2017. In
addition, while the death rate for rural children dropped 19 percent
between 1999 and 2017, from 77.6 per 100,000 children to 62.9 per
100,000, the decline among urban children was significantly greater-a
decrease of 24 percent, from 66.4 per 100,000 to 50.2 per 100,000. Among
rural children, non-Hispanic black infants and American Indian/Alaska
Native children were particularly at risk. Read More >>

This study will also appear in the journal's December issue, Rural
Health.

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HEALTH INFORMATION TECHNOLOGY

Are Patients Electronically Accessing Their Medical Records? Evidence
From National Hospital Data

By Sunny C. Lin, Courtney R. Lyles, Urmimala Sarkar, and Julia
Adler-Milstein

Substantial policy effort has been directed at improving patients'
ability to access and use electronic health records. Using nationwide
data from 2,410 hospitals for the period 2014-16, Sunny Lin and
coauthors examined associations between patient- and hospital-level
characteristics and access to and use of electronic health record data
among discharged patients. Read More >>

Listen to author Sunny Lin interviewed about this article on WTOP-FM

HOSPITALS

Did Hospital Readmissions Fall Because Per Capita Admission Rates Fell?

By J. Michael McWilliams, Michael L. Barnett, Eric T. Roberts, Pasha
Hamed, and Ateev Mehrotra

In general, readmission rates should fall as admission rates fall
because the probability of an admission occurring soon after another is
lower when there are fewer admissions per patient. J. Michael McWilliams
and coauthors examined this relationship by conducting a simulation in
which we removed random samples of admissions from Medicare claims data
and recalculated readmission rates. Read More >>

MEDICAID

Medicaid Expansion Associated With Reductions In Preventable
Hospitalizations

By Hefei Wen, Kenton J. Johnston, Lindsay Allen, and Teresa M. Waters

To examine the impact of Medicaid expansion under the ACA, Hefei Wen and
coauthors reviewed inpatient databases for the years 2009-15. The
authors found that the Medicaid expansion states saw greater reductions,
compared to non-expansion states, of the number of patients hospitalized
for conditions that could have been treated by ambulatory care
interventions. Read More >>

PHARMACEUTICALS & MEDICAL TECHNOLOGY

Little Consistency In Evidence Cited By Commercial Plans For Specialty
Drug Coverage

By James D. Chambers, Ari D. Panzer, Elle F. Pope, Jennifer S. Graff,
and Peter J. Neumann

Researchers have reported wide variation in how commercial health
insurance plans cover specialty drugs, which suggests that a patient's
health plan can determine their access to these treatments. James
Chambers and coauthors used information from the Tufts Medical Center
Specialty Drug Evidence and Coverage Database to examine the evidence
that plans reported reviewing in specialty drug coverage policies. Read
More >>

Biosimilar Filgrastim Uptake And Costs Among Commercially Insured,
Medicare Advantage

By Pinar Karaca-Mandic, Jessica Chang, Ronald Go, Stephen Schondelmeyer,
Daniel Weisdorf, and Molly Moore Jeffery

Pinar Karaca-Mandic and coauthors report on the uptake and costs of the
first biosimilar in the US market, filgrastim-sndz (Zarxio). Following
rapid uptake, by March 2018 filgrastim-sndz accounted for 47 percent of
filgrastim administrations among the commercially insured and 42 percent
among Medicare Advantage beneficiaries. Read More >>

DISPARITIES

Medicaid And Private Insurance Coverage For Low-Income Asian Americans,
Native Hawaiians, And Pacific Islanders, 2010-16

By John J. Park, Benjamin D. Sommers, Sarah Humble, Arnold M. Epstein,
Graham A. Colditz, and Howard K. Koh

John Park and coauthors take a close look at the effects of the ACA on
Medicaid and private insurance coverage for low-income Asian Americans,
Native Hawaiians, and Pacific Islanders. The authors report large gains
in coverage in the period 2010-16 in both Medicaid expansion and
nonexpansion states. Read More >>

ACCESS TO CARE

A Consumer-Centric Approach To Network Adequacy: Access To Four
Specialties In California's Marketplace

By Simon F. Haeder, David Weimer, and Dana B. Mukamel

Simon Haeder and coauthors incorporate more accurate practicing
physician data and measures of patients' travel distance into
traditional approaches for measuring health plan network adequacy.
Focusing on four physician specialties in California, they show that
"Marketplace plan networks are consistently narrower than their
commercial plan counterparts." Read More >>

MEDICARE

Association Of Medicare's Annual Wellness Visit With Cancer Screening,
Referrals, Utilization, And Spending

By Ishani Ganguli, Jeffrey Souza, J. Michael McWilliams, and Ateev
Mehrotra

Medicare's annual wellness visit was introduced in 2011 to promote
evidence-based preventive care and identify risk factors and undiagnosed
conditions in aging adults. Use of the visit has risen steadily since
then, yet its benefits remain unclear. Using national Medicare data for
2008-15, Ishani Ganguli and coauthors examined claims from
fee-for-service Medicare beneficiaries attributed to practices that did
or did not adopt the visit. The authors performed
difference-in-differences analysis to compare differential changes in
appropriate and low-value cancer screening, functional and
neuropsychiatric care, emergency department visits, hospitalizations,
and total spending. Read More >>

Read the November 2019 Table of Contents

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About Health Affairs

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Update .  

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